Another Trial Right Question

[sshafran]

Ok, so I thought I had this thing down pretty well....

Evidently I'm an amateur not ready for the big leagues


So my client T65 in April 2015 and we went with an MAPD HMO.

She is now considering a supplement due to the referral restrictions...asked for deadline on that, and I told her that her real deadline is the end of March to switch to supp using trial right, but to switch to another mapd it is 12/7...

So then she doesn't know which one she'll want, we have an hmo here that is new and good not requiring referrals...so she wants to consider that...then asks, "If I go with this new advantage plan for next year, then decide that I do want the Supplement, can I still make that switch in March?"

Hm.....

So she would still be in the 1st year, but it would be her 2nd MAPD. Would the SEP65 on her PDP go through as well as GI on supp?

Inquiring minds want to know...

 

[Chazm]

Good question, I would assume she would be ok since its within her first year on a MAPD. The rule doesn't specify that it can be only one

 

[haggy641]

When it comes to SEP 65, the rule states "Begins month enrolled in MA for first time, ends 12 months after effective date". What it doesn't state is "...ends 12 months after effective date or date plan terminates, whichever is earlier." so the SEP 65 should work for the Part D.

For the Trial Right on a Medsupp, it all comes down to the carrier's interpretation of the rule. It's worth reaching out to the carrier you're thinking about directly to see how they would interpret it.

 

[sshafran]

Good question, I would assume she would be ok since its within her first year on a MAPD. The rule doesn't specify that it can be only one

That's my assumption. I'm guessing that someone has run into this before...

----------

For the Trial Right on a Medsupp, it all comes down to the carrier's interpretation of the rule. It's worth reaching out to the carrier you're thinking about directly to see how they would interpret it.

So I reached out to Anthem broker support and they said no, that they would interpret the AEP change to be no longer her first time in an MAPD and SEP 65 invalid.

 

[Chazm]

That's my assumption. I'm guessing that someone has run into this before... ---------- So I reached out to Anthem broker support and they said no, that they would interpret the AEP change to be no longer her first time in an MAPD and SEP 65 invalid.

Well hot damn. That sucks.

 

[sshafran]

Well hot damn. That sucks.

Yup.

She kinda wants to try the new mapd and may end up staying with them, but doesn't want to lose the GI at the same time...

It's possible that they got it wrong. But the guy I talked to at Anthem seemed to know his stuff and put me on hold for about 7 minutes while he asked his supervisor for clarification.

 

[G.Gordon]

Trial right is for her "first time" on MAPD. If during a SEP or AEP she changes to another MAPD, she is on her "second time" with MAPD. Trial right ended when the first MAPD was termed.

Some tier 2 companies such as UNL or Oxford may interpret it differently, but most main line companies such as AARP, MOO, BCBS, etc. will take it to the letter of the regulation.

Another example is: T65 May 1, eligible for retiree benefits, stays on three months, finds that MAPD off the street is better, moves to MAPD for August 1. Technically this is not a Trail Right eligible person. The first choice was to take retiree benefits. Been down this road and ended up getting a "yes" from only two out of ten companies, those mentioned above.

 

[goillini52]

Ok, so I thought I had this thing down pretty well....

Evidently I'm an amateur not ready for the big leagues


So my client T65 in April 2015 and we went with an MAPD HMO.

She is now considering a supplement due to the referral restrictions...asked for deadline on that, and I told her that her real deadline is the end of March to switch to supp using trial right, but to switch to another mapd it is 12/7...

So then she doesn't know which one she'll want, we have an hmo here that is new and good not requiring referrals...so she wants to consider that...then asks, "If I go with this new advantage plan for next year, then decide that I do want the Supplement, can I still make that switch in March?"

Hm.....

So she would still be in the 1st year, but it would be her 2nd MAPD. Would the SEP65 on her PDP go through as well as GI on supp?

Inquiring minds want to know...

There was actually a thread about this a while back. Some companies say yes...some say no. I called Aetna about it and they told ne that it was OK to have had 2 different MA's as long as she goes to a Med Supp within the year. I talked to more than one person and one was an UW. Of course if I called again, I might get a different answer.

I'd check with the different companies you have in your bag and see what they say.

 

[TwoCents]

To be safe I'd say the cut off is 2/14 -- us the MADP election to leave the MAPD and enroll into a PDP to go with the med supp. Any MA chosen during AEP would be her 2nd and I wouldn't risk a carrier denying her the MAPD termination down the road.

 

[bluediamond]

Yup.

She kinda wants to try the new mapd and may end up staying with them, but doesn't want to lose the GI at the same time...

It's possible that they got it wrong. But the guy I talked to at Anthem seemed to know his stuff and put me on hold for about 7 minutes while he asked his supervisor for clarification.

Yes, he is correct the trial is only for the 1st MAPD, if changed in AEP that right is given up. Wish I could find a link, but a couple of us ran into this last year. I don't think carrier's can change a CMS rule.